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Pending decision before C&P???

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2NDMARDIVDOC

Question

Hello and thank you in advance. I'm pretty confused on what is happinging with my claim. A month ago I filed a FDC for PTSD, a bladder condition and a shoulder condition. I submitted quite a bit of medical evidence for all of them as well as a completed DBQ from my private psych doc for the PTSD clam. Within a week enenefits changed from received to gathering evidence to pending decision approval. At no point did the VA order me any C&P exams yet the claim went through all those phases. Then today I get a call from the VA trying to schedule me for a C&P for the bladder and shoulder. My question is if they could grant my PTSD and start paying me before they get the exams back on the other 2 issues?? I just can't understand why ebenefits would say pending decision approval otherwise. Any knowledgeable info is  appreciated. 

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2 hours ago, Berta said:

I didnt realize you had  already filed again for the bladder condition.

If VA had denied the shoulder, and PTSD ( the CUE post was about the bladder condition)

you will need new and material evidence (N & M) to re-open any previously denied claim.

I was thinking over the other posts and I feel the bladder condition should be re opened under 3,.156 as well as with a CUE claim too. The N & M you have ( the discharge cert and post service treatment records.) I hope they didnt deny again if they didnt get any new and material evidence.Did you send them copies of that stuff or attach it at ebenefits?

VA will not accept a PTSD diagnosis unless it comes from a VA MH health care provider....however did they deny PTSD in the past, via a C & P exam,  and yet now have made a decision without a C & P?

It is possible they made a CUE in the past denial.????

This is all confusing.

Are you rated at all for a TBI?

Can you tell us what your SC ratings are for?

"pending decision approval" only means they are seeking approval on the decision from some GS level higher than their level....it could mean denial or award.

 

 

 

Berta, 

ok. Here is the exact language from my rating decision back in 02 where they denied SC for my bladder condition 

"Service medical records dated 11-07-01 showed veteran was seen at the department of urology for irritative voiding symptoms  the cystosscopy report showed normal urethra no stricture. The prostate was nonobstructive. Assessment  was overactive bladder and was treated with a Detrol. It was also stated on this report that a scrotal ultrasound should be completed to rule out varicocele and other pathology. The veteran was released from active duty on 12-14-01with no evidence of this being completed. Seperation examination showed overactive bladder not considered disabling. VA examination from Bay Pines medical center stated the veteran had a complaint of chronic overactive bladder. He was checked by his primary doctor, he was negative for diabetes and was seen by the urologist and there were no problems noted. Diagnostic assessment was history of overactive bladder. No objective findings. The rule regarding benefit of reasonable doubt does not  apply because the preponderance of evidence is unfavorable"

ok so what exact objective findings were they looking for??? Overactive bladder is rarely secondary to anything, it's usually the primary issue. It was documented in my military medical physical, I was put on meds, I had a bunch of tests, how could they deny me just because they couldn't attach it to something else?? I mean take migraines for example. Vets get SC for them all the time and there is only subjective evidence, there is no diagnostic confirmation. So what makes overactive bladder any different? 

 

Edited by 2NDMARDIVDOC
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"what exact objective findings were they looking for"

That is why I asked if it was a ratable condition.....And if it is now....

The BVA case I gave you has their rating criteria in it.

You need to go over your SMRS and current medical records to see if the VA missed anything and should have rated this, even if the rating was "0" SC.

 "I mean take migraines for example. Vets get SC for them all the time and there is only subjective evidence, there is no diagnostic confirmation. " But there is an established reason ( a service nexus)for the migraines if the VA compensates them.They could be from a TBI,for example.

Has any doctor diagnosed any inservice condition you had that would cause the bladder problem?

 

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Berta, 

im not sure what the law or criteria was regarding bladder conditions was back in 02. And to the best of my knowledge I was never dx'd with anything that my bladder condition could be tied to. It's a condition of and in itself. I DO HAVE A NEXUS from my VA primary care that says, in his medical opinion my bladder condition did occur in service and used my discharge physical as evidence for his opinion. I did not have that nexus at the time I filed back in 02. And yes I did submit it with my most recent claim. 

I have reviewed the recent rating criteria for bladder conditions and according to them I meet the 40-60% rating. 

So let's assume for a minute that they do grant me SC this go around and that the requirements are the same now that they were back in 02 when I got denied, would that support a CUE? 

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In the VA's program there's a place to track all the things that are out; a pending exam, requests for service records, perhaps a PTSD stressor statement. If all the items aren't put into the tracker, and someone clicks the last item as received, it automatically goes to rating, ready or not.

Very likely this is what happened, if I understand correctly what you're saying.

You don't need new and material within a year of a denial, it's termed a 'reconsideration'

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"

"Berta, 

im not sure what the law or criteria was regarding bladder conditions was back in 02."

That is a good point. I do not think it has changed since then but if I have time later I will check that out....or you could.... go to www.bva.gov, click on their search feature and use 'overactive bladder' for the search terms and click on the years prior to and including when the decision was made.

"And to the best of my knowledge I was never dx'd with anything that my bladder condition could be tied to. It's a condition of and in itself. I DO HAVE A NEXUS from my VA primary care that says, in his medical opinion my bladder condition did occur in service and used my discharge physical as evidence for his opinion. I did not have that nexus at the time I filed back in 02. And yes I did submit it with my most recent claim." 

The opinion has to show how the condition fits into a ratable criteria, with a full medical rationale referencing  documented symptoms and treatment.

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20 minutes ago, Berta said:

"

"Berta, 

im not sure what the law or criteria was regarding bladder conditions was back in 02."

That is a good point. I do not think it has changed since then but if I have time later I will check that out....or you could.... go to www.bva.gov, click on their search feature and use 'overactive bladder' for the search terms and click on the years prior to and including when the decision was made.

"And to the best of my knowledge I was never dx'd with anything that my bladder condition could be tied to. It's a condition of and in itself. I DO HAVE A NEXUS from my VA primary care that says, in his medical opinion my bladder condition did occur in service and used my discharge physical as evidence for his opinion. I did not have that nexus at the time I filed back in 02. And yes I did submit it with my most recent claim." 

The opinion has to show how the condition fits into a ratable criteria, with a full medical rationale referencing  documented symptoms and treatment.

Thank you. I'll check it out today. Correct me if I'm wrong but based on what I sent you regarding the language from the original denial letter, they recognized the Facebook the bladder condition started in service, required medication,  multiple disgnostic tests were performed etc yet they say that the "Perpondance of evidence" does not support SC.....  I just don't understand how the hell they can say that?? It seems that they are saying if they can't tie the bladder to another condition, it's not connectable. That's just not accurate. "Voiding dysfunction" is a rating category all by itself and includes overactive bladder. Am I missing something? It seems pretty clear cut to me. 

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